The sudden drop in weight some women experience on Ozempic can feel like an unexpected windfall. Yet, the come-down is real, and for many, it arrives with a thud. In my practice, I've seen this narrative unfold: the initial euphoria of weight loss, followed by the creeping dread of a slowed metabolism and the accompanying weight regain. The solution? A carefully crafted off-ramp.
Understanding GLP-1 and your metabolism
Ozempic (semaglutide) works by mimicking GLP-1 (glucagon-like peptide-1), a hormone that regulates appetite and insulin. According to the European Medicines Agency's product information, semaglutide "reduces body weight and body fat mass through lowered energy intake, involving an overall reduced appetite", and it slows early gastric emptying so you feel full for longer (EMA, Ozempic SmPC). It is worth knowing that Ozempic itself is approved as an adjunct to diet and exercise for blood-sugar control in adults with type 2 diabetes; the higher-dose weight-management version of semaglutide is marketed as Wegovy (FDA prescribing information, 2025).
When the medication stops, the appetite and hunger signals it was quietening return. The best data we have comes from the STEP 1 trial extension: one year after stopping once-weekly semaglutide 2.4 mg (and the lifestyle support that went with it), participants had regained about two-thirds of the weight they had lost, and most of the improvements in blood pressure, lipids and blood sugar had drifted back towards where they started (Wilding et al., 2022). Without a plan, old eating patterns return quickly.
For South African women over 40, this metabolic shift can be particularly challenging. The Study of Women's Health Across the Nation found that at the start of the menopause transition the rate of fat gain doubles and lean mass begins to decline, and that this continues until about two years after the final period (Greendale et al., 2019). Adding the rebound effect from Ozempic on top of that can make the challenge steeper.
Building your off-ramp
Preparing for life after Ozempic requires a proactive approach. Start by integrating gradual lifestyle changes well before you plan to stop the medication. Focus on sustainable habits rather than short-term fixes. Begin with a balanced diet rich in whole foods. Prioritise lean proteins, healthy fats, and plenty of fibre to support metabolic health and satiety.
Exercise is non-negotiable. Strength training, in particular, helps maintain muscle mass, which is crucial for a healthy metabolism. The World Health Organization's 2020 guidelines recommend regular muscle-strengthening activity for all adults, alongside 150–300 minutes of moderate-intensity aerobic activity a week (Bull et al., 2020). Aim for at least two to three strength sessions a week, complemented by brisk walking or cycling.
Supporting your nervous system
The nervous system often takes a hit during this transition. As your body adjusts to changes in hormone levels, stress can amplify, leading to anxiety and disrupted sleep. Incorporating practices such as mindfulness meditation, yoga, or deep breathing exercises can help regulate your nervous system.
Consider integrating therapies like red light and ozone therapy, which I offer in my practice, as supportive layers alongside the food and movement work.
Regular monitoring and support
Your GP or a functional medicine practitioner can be invaluable in this process. Regular monitoring of your metabolic markers — such as blood sugar levels, insulin sensitivity, and lipid profile — can provide insights into your body's response post-Ozempic. Adjusting your strategy based on these metrics ensures you're not flying blind. Any change to your medication or dose should always be made with your prescribing doctor.
Remember, this journey is uniquely yours. What works for one person may not work for another. The key is to listen to your body and adjust your plan as needed. This is exactly what the Metabolic Support & GLP-1 Coaching programme and the Post-GLP-1 Protocol are built for.
If you're considering transitioning off Ozempic or if you've already begun and are seeking support, I invite you to book a free 20-minute consult with me. Let's discuss a personalised plan to support your health and well-being.
Your support coach
Christine x
Sources
- European Medicines Agency. Ozempic (semaglutide) — Summary of Product Characteristics, section 5.1 Pharmacodynamic properties. https://www.ema.europa.eu/en/documents/product-information/ozempic-epar-product-information_en.pdf
- US Food and Drug Administration. OZEMPIC (semaglutide) injection — Prescribing Information, 2025: Indications and Usage; 12.1 Mechanism of Action. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/209637s025lbl.pdf
- Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes, Obesity and Metabolism. 2022;24(8):1553–1564. doi:10.1111/dom.14725. https://pmc.ncbi.nlm.nih.gov/articles/PMC9542252/
- Greendale GA, Sternfeld B, Huang M, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865. doi:10.1172/jci.insight.124865. https://pmc.ncbi.nlm.nih.gov/articles/PMC6483504/
- Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. 2020;54(24):1451–1462. doi:10.1136/bjsports-2020-102955. https://pmc.ncbi.nlm.nih.gov/articles/PMC7719906/
Book your free 20-minute consult or read the Metabolic Support & GLP-1 programme.